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General NPI Number Information
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NPI Number | 1144823899
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Entity Type | Individual
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Provider Name | KENNEDY MILLER PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/17/2020
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Last Update Date | 11/11/2025
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Provider Practice Location Address
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Address Line | 175 ROUTE 130 S
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City | CINNAMINSON
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State | NJ
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Zip | 08077-3376
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Country | US
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Telephone | 856-536-1640
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Fax |
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Provider Business Mailing Address
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Address Line | 1 FEDERAL ST STE 200
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City | CAMDEN
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State | NJ
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Zip | 08103-1088
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Country | US
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Telephone | 848-288-6935
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Fax | 732-790-0107
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | NJ
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